Wednesday, July 07, 2010

thirty, thirty-two

Geoff is sitting on the edge of the sofa, his legs pressed together and a pillow clutched to his middle. What light there is spilling in through the sitting room window is absorbed by the pallor of his face, flat as cream.
Alan, his partner, stands over by the mantelpiece and folds his arms.
I go over to Geoff and squat down beside him.
‘What’s happened, then?’
‘I was sick,’ he whispers. ‘I threw up blood.’
‘He threw up loads of blood. Three times. I’m so worried,’ says Alan, unfolding his arms, then straightaway folding them again.
‘Have you been feeling unwell through the day?’ I ask Geoff, feeling his pulse. Regular, sufficient.
‘No. I was fine.’
‘Did you get any warning you were going to be sick?’
‘Some. We’d eaten, I felt a bit dizzy, and when I came in here to lie down on the sofa I had to rush into the bathroom.’
‘Have you flushed the toilet since?’
‘I left it in case you wanted to look.’
‘Let’s see.’
I leave Geoff sitting there and follow Alan into the bathroom.
It’s a startling effect: the bathroom brightly lit, scrubbed and neat, a linear pattern of clean grouting, bleached white shower curtains, chrome towel rails, cute trinkets and mirrors – and then a splattered brown and red mess around the rim of the toilet. Inside, the bowl is full and dark.
‘And Geoff has thrown up like this three times?’
‘Yes. God – what do you think it is?’
We go back into the sitting room.
‘Do you have any pain at the moment?’ I ask him, putting on a SATS probe.
‘No.’
‘Any other strange feelings anywhere?’
‘No. A bit dizzy still, that’s it.’
‘What medical problems do you have?’
‘Nothing.’
‘Any family history of anything? Stomach ulcers, digestive problems? Anything like that?’
‘No.’
‘Any recent operations?’
‘No. Except for some root canal treatment. But that was two years ago.’
‘And your health has been okay recently?’
‘Fine.’
‘Let’s have a feel of your tummy.’
He lies back and pulls up his t-shirt. Everything looks okay.
‘Tell me if anything hurts.’
The only time he winces is when I press to the right of his abdomen, about where his liver is.
‘Eating and drinking okay?’
‘Yes.’
‘What about alcohol? How much would you say you got through a week?’
‘Nothing much. Hardly anything.’
‘Bowel movements all right?’
‘Yes.’
‘And nothing out of the ordinary in any other respect?’
‘No. What’s wrong? What’s the matter with me?’
‘I don’t know, Geoff. It looks like you’ve had a significant bleed either from your stomach or high up in your digestive system, but I don’t know why. It’s a trip to hospital, I’m afraid.’
He starts to cry.
‘Why didn’t I listen? Why?’
‘What do you mean?’
‘You have to tell them everything, Geoff. They have to know.’
‘Know what?’
‘It’s so embarrassing,’ he sobs. ‘I can’t bear it.’
‘What? What’s been happening?’
Alan sits down with him on the sofa and takes his hand.
‘He’s been using pain killers. Nurofen Plus.’
‘Okay. How many?’
Alan hands him a tissue. Geoff blows his nose, collects himself, then stares down at his hands as they gently tear the tissue into pieces.
‘Thirty, thirty two,’ he whispers.
‘A day?’
‘I knew it was bad but I just couldn’t help myself.’
‘For how long?’
‘Since the tooth operation.’
‘Two years?’
‘About that.’ He looks up. ‘I’ve done some damage, haven’t I? I knew I would but I couldn’t stop myself. What’s going to happen to me?’
‘First things first,’ I say. ‘Let’s get some shoes on, keys, phone, wallet. Let’s get you up the hospital where we can start to get you better.’
Alan gets the stuff together whilst Geoff sits quietly.
‘It’s so embarrassing,’ he says.
‘It’s an addiction, that’s all. It’s been a problem for a while, but today’s the day you start to do something about it.’
‘I’ve taken so many, though.’
‘You have. But it’s surprising how many people are in the same boat. One step at a time, though. Let’s get you to a doctor and see what they have to say. There’s lots to be done.’
He rolls the shredded tissue into a ball and tosses it into a bin.
Alan comes over with his slippers.

I remember being on holiday on an island with my parents when I was about 15, and having the most horrific toothache that the Disprin we had with us just wasn't touching. My dad told me that the recommended dosage on the box was just the drug companies covering their backs. 'Oh really?' I said. 'Yes', he replied casually, 'You're fine to take them until your ears start ringing'. Funnily enough it wasn't advice I followed, yet he's wise in so many other ways.

Sorry to hear you're at a low ebb, Andy. Hope you feel better soon. If you were here I'd buy you a pint (I'm off to the pub in a minute :) )

Thanks v much for the comment. I'm guessing Geoff has caused some gastric ulceration at that level of abuse. But I was reading around the subject, similar patients making a good recovery (with adjusted diet and medication), so I think the prognosis is probably good. Codeine in particular is very addictive. It's an easy habit to form.

Hey Fiona

Well - (I'm no expert, but...) you shouldn't really give aspirin or other NSAIDs to under 16s because of Reye's syndrome. Apart from that, he's right, in that it is a low overdose caution, I think, the biggest risk being stomach irritation. Long term it can cause a lot of other damage, though.

BTW - he's def not right if he's thinking about any other pain killers. Paracetamol has to be taken at the recommended dose, because of the harm it does to your liver at even moderately raised levels. I know I'm prob overly cautious about this stuff (I hesitate to eat a yoghurt out of date by a couple of days), but I would always follow the instructions in the pack.

Not sure about the ringing. I have heard about aspirin causing tinnitus, but don't know about what that indicates about levels / sensitivity etc.

There's something about this story, I'm not sure what. I've faced temptation a number of times over taking a load of pills, but there's something about the way that it sounded like this crept up on Geoff and despite knowing what he was doing in the end, and his partner knowing he couldn't help himself. I hope he does ok and gets the help he needs.

Both salicilates (aspirin) and NSAIDs can cause or worsen tinnitus - not specifically dose-related I don't think, it depends on the person and reducing a dose that makes your ears ring obviously would help and it will usually go away again. The other stuff that causes it such as cis-platin (cancer drug) is irreversible - the effect is sudden (overnight) and severe. But as my husband said: "Deaf or dead - no-brainer really". Antibiotics can cause tinnitus too. But that is also reversible in the long term mostly.

I think you're right, Miranda - it must have crept up on him over time. I think he knew it would hurt him in the end, but there's an element of respectability / normality about buying OTC painkillers. And if you're buying quite a few, I bet there are ways you can explain it to yourself.

I hope he gets plenty of help, too. I'm sure he will.

Thanks for the comment.

Hey Eileen

Thanks v much for that.

Amazing that so many different drugs should cause ringing in the ears. I wonder why? Good to hear that it's reversible.

Mum with permanent back and hip pain has taken NSAIDS for years for pain along with Tramadal and Parcetamol, she had a liver function test a few months ago and it was only producing at 7%, Doc took her off them straight away and she had another last week and it's nearly back up to full function.

There's no end to the stuff you can get addicted to. Amazing, the blind accommodations you make - how these things can become so much a part of your daily routine that you stop seeing the damage they're doing and simply carry on regardless. x

There was actually a case here in Winnipeg a few years ago of a man who commited suicide because of non-stop tinnitus that continued for over ten years. I can actually understand that having had episodes myself. They are horrible!

I have also used a TENS machine for neck and back pain and I found it quite helpful.